Comparative Analysis of the Efficacy of Extracorporeal Shockwave Lithotripsy vs. Ureteroscopy on Ureterovesical Junction Stones After Failed Medical Expulsive Therapy

Comparative Analysis of the Efficacy of Extracorporeal Shockwave Lithotripsy vs. Ureteroscopy on Ureterovesical Junction Stones After Failed Medical Expulsive Therapy
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Title:Comparative Analysis of the Efficacy of Extracorporeal Shockwave Lithotripsy vs. Ureteroscopy on Ureterovesical Junction Stones After Failed Medical Expulsive Therapy
Author/Abstract:

John Ivan S. Alonzo, MD; David T. Bolong MD, FPUA and Jerry H. Santos, MD, FPUA
Section of Urology, Department of Surgery, University of Santo Tomas Hospital

Objective: The study aimed to determine the stone-free rate (SFR) of Extracorporeal Shockwave
Lithotripsy (ESWL) on Ureterovesical Junction (UVJ) stones which failed to resolve after Medical
Expulsive Therapy (MET.) The SFR of ESWL for UVJ stones is compared to that of Ureteroscopy in
order to assess the efficacy of ESWL.

Methods: This is a pilot case-series which utilized patient charts from UST Hospital and Manila
Lithotriptors, Inc. from January 2010 to August 2015 with UVJ stones that failed to resolve after 2
weeks of MET. These patients subsequently underwent either ESWL or URS for active management
of UVJ stones. Stone-free status was determined on 2-week follow-up using repeat imaging. Patient
demographics and stone-free rates were subjected to statistical analysis. Patient age and stone size
were tested for normal distribution using Shapiro-Wilk test. T-test for two-sample assuming equal
variances was used to test for the significance of any noted difference. Data on gender were analyzed
using Fisher Exact Probability Test.

Results: Nineteen patients fulfilled the inclusion criteria of this study. Seven patients underwent
ESWL while 12 patients underwent URS. No statistical significance was observed for patients’ age
and gender. There was a significant difference in mean stone size between the two groups; 0.5 cm for
ESWL and 0.7 cm for URS. Stone-free rates of ESWL and URS were 85.7% and 83.3%, respectively.
Fisher Exact Probability test revealed no significant difference in SFR between the 2 groups. In
addition, there was poor correlation between stone free rate and the type of procedure done.

Conclusion: Extracorporeal shockwave lithotripsy is a viable option in treating UVJ stones after failed
MET with a SFR of 85.7%. In comparison to URS, there is no significant difference with ESWL for
UVJ stones in terms of stone-free rates.

Key words: extracorporeal shockwave lithotripsy, ureteroscopy, ureterovesical junction stones

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